Get The Calpers Long-term Care Program Assignment Of Benefits Bb

Filling out the CalPERS Long-Term Care Program Assignment of Benefits Bb form online is a straightforward process that ensures your long-term care benefits are directed appropriately. This guide provides clear, step-by-step instructions to help you complete the form accurately and effectively.

Follow the steps to complete the form successfully.

1. Click the ‘Get Form’ button to obtain the form and open it in your document editor.
2. Enter the date in the specified field at the beginning of the form. Ensure the date is accurate and formatted correctly as per instructions.
3. In the 'Claimant Name' section, provide the full name of the claimant as it appears on their identification documents.
4. Fill in the 'Coverage ID Number' field with the appropriate ID number provided by CalPERS, ensuring it is correct to maintain processing accuracy.
5. In the authorization section, indicate the name of the individual or entity to which the long-term care benefits should be paid. Be sure to confirm that the name matches the entity registered with CalPERS.
6. Sign the form in the designated area both as the claimant and the independent provider. Ensure printed names are clearly written underneath the signatures for verification purposes.
7. If applicable, attach any necessary legal documentation of guardianship or representative capacity to support the authority of the person signing.
8. Provide the address of the independent provider in the specified fields, ensuring all elements of the address are completed accurately.
9. Enter the last four digits of the independent provider's social security number in the appropriate field to further authenticate the process.
10. Once all sections have been completed, review the form thoroughly for accuracy. Save the changes, download the completed form, and prepare it for submission.
11. Submit the completed form and attachments to CalPERS via mail or fax as indicated in the instructions. Ensure you retain a copy for your records.

Complete your CalPERS Long-Term Care Program Assignment of Benefits Bb form online today to ensure timely processing of your benefits.